Program Operations Manual System (POMS)

HI 03010.035 General Information about the Subsidy Application

The MMA allows individuals to file for the subsidy with either SSA or a State Medicaid office. The law also required that CMS and SSA jointly develop an application for determining eligibility for the subsidy. SSA and CMS considered comments from States, advocacy groups, focus group participants and SSA regional coordinators when developing this application.

States have the option of using the CMS-SSA form (SSA-1020-OCR), SSA’s Internet application (i1020), or their own application. However, if a State Medicaid office chooses to use an application other than the SSA-1020 or i1020, that State Agency will make the eligibility determinations for those applications. States using the SSA-1020-OCR may forward the application to SSA to process. The instructions below apply to applications that will be processed by SSA.

This is a self-help form. It will be mailed to Medicare eligible individuals who appear to meet the income limits based solely on computer matches with other agencies. The form will also be distributed at outreach events and used by State agencies and advocacy groups. It can be completed by the claimant or a personal representative filing on behalf of the claimant (see HI 03010.010B.). When completed, the SSA-1020-OCR is sent to the WBDOC to process as explained in HI 03010.040C.2. See HI 03010.038B.1. if the completed form is received in a field office (FO).

The SSA-1020-OCR is available in English and Spanish. SSA’s web site will contain facsimiles of the SSA-1020 in 14 languages that an applicant can use to complete the SSA-1020-OCR. The facsimiles are not scannable and should not be completed or forwarded to WBDOC.

SSA FO and Workload Support Unit (WSU) staffs will complete in-person and telephone application interviews asking questions that are presented on a series of screens in the new MAPS. MAPS was developed specifically for the subsidy. Some questions on the MAPS are worded and presented differently than questions on the scannable form, but they elicit the same information.

The Internet application (i1020) is an interactive self-help form designed to capture all inputs by the claimant (or third party on behalf of the claimant) and subsequently propagate this data to the Medicare Determination process without any intervening action by an adjudicator. The screens are similar to, and elicit the same information as, MAPS screens and the scannable application. However, easy-access Help screens containing additional explanatory information are also available on the i1020 for most questions. The i1020 is available in English and Spanish. It can be accessed via the following website: www.socialsecurity.gov/prescriptionhelp .

NOTE: Although the screens are similar, the i1020 does not use or interface with MAPS screens to input subsidy application data to the Determination process. However, once accepted, MAPS screens are used to query and/or change data in an application entered via the i1020.

The following information is being provided solely to help respond to inquiries that may be received about the i1020.

Who Should Complete the Subsidy Application?

Claimants may use the i1020 to apply for the subsidy if:

they have or are eligible for Medicare Part A and/or Part B; and

they live in one of the 50 states or the District of Columbia; and

their combined savings, investments, and real estate (other than their home) is not worth more than $13,300 ($13,070 in 2012) if they are single, or $26,580 ($26,120 in 2012) if they are married and living together.

NOTE: Even if the above amounts are exceeded, claimants may still be eligible for the subsidy – but they will have to contact their state Medicaid agency to find out. However, claimants may still enroll with an approved Medicare prescription drug provider for Part D coverage – whether or not they are eligible for the subsidy. To obtain a list of Medicare-approved prescription drug providers in their area, claimants may call CMS toll-free at 1-800-MEDICARE (1-800-633-4227) or visit www.medicare.gov. If they are deaf or hard of hearing, they may call the Medicare TTY number toll-free at 1-877-486-2048.

Who Should Not Complete the Subsidy Application

Some claimants will be deemed eligible for the subsidy and should not complete an i1020 (or any other subsidy application). Claimants who should not file include those:

who receive SSI payments and have Medicare;

who receive Medicaid with prescription drug coverage and have Medicare; or

whose state pays for their Medicare premiums (e.g., QMBs, SLMBs and QIs).

These claimants will be contacted separately by CMS about their subsidy. CMS will also notify them of the plan selection and provide instructions for changing plans or opting out of enrollment. If they don’t want to wait to be contacted, they may call CMS toll-free at 1-800-MEDICARE (1-800-633-4227) or visit www.medicare.gov. If they are deaf or hard of hearing, they may call the Medicare TTY number toll-free at 1-877-486-2048.